Pelvic Pain

A 35 year old woman presents with sudden onset right-sided lower abdominal and pelvic pain. She said the pain started when she was "exercising," but upon further inquiry, it occurred when she was having sex. This was accompanied by light vaginal bleeding. Her past medical history is significant for appendectomy at age 20. The only medication she takes is aspirin for knee pain.

On exam, temperature is 38.1, heart rate is 75, blood pressure is 115/85, respiratory rate is 12, O2 sat is 99% on room air. On abdominal exam, right lower abdomen is moderately tender to deep palpation. On vaginal exam, an adnexal mass is barely palpable on bimanual examination. There is minimal cervical motion tenderness.

A serum hCG is undetectable. CBC is normal. Urinalysis is normal. Blood culture, urine culture, and cervical studies are negative for infection. Ultrasound shows an adnexal mass and fluid in the pelvis. A CT is shown below.

Challenge: Oral analgesia as an outpatient is the treatment for this condition if uncomplicated. What is it?

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